Insurance & Financing

Ok I know nothing about insurance, I'm 24 years old, and I never had medical insurance, I live in Houston, TX and I was looking into getting insurance that will cover lap band, I now weigh 268 lbs, and I've been overweight my whole life but this is the biggest I ever got, I need help and information, I'm getting so depress because I don't want to gain anymore weight.

I am curious. When you were on the supervised diet for insurance, how much did you lose? Was it a 3 month or 6 month program?

Hi everyone... I am new here. I am living in Texas. I have TRS Active Care BCBS of Texas. I know that I have to have a 6 month physician supervised diet & 5 year history. I don't have any problem documenting the 5 year history through my PCP. However, I think I might have to go through the 6 month diet thing with my PCP. My question is, does the diet have to be an uninterrupted 6 month period of time? I'm questioning this because when I went to my PCP the other day, she asked if my 4 months with Weight Watchers and working out would count towards the 6 month requirement. I'm not sure, but I really hope so. That way, I'm thinking that I'll only have 2 more mon…

Okay, I finally got all my medical records together. 4 states and 12 doctors - and not a damned one of them was consistant with putting my weight on there! I have weights entered for the following years: 1999, 2003 and 2006 - uuhhhh what about the other years?! Was I in some anti-gravity bubble in your office that made it so I had no weight?! I had a blood pressure and a height, but no freaking weight! And the kicker is, for most of these visits, I was going for WEIGHT RELATED ISSUES! And they wonder why its so hard to get approved! Insurance companies can't be blamed for this type of thing, but doctors' can certainly use my boot in their arses for this kind of cr…

Hi, is there a broader list of health reasons... insurance companies look for when approving the Lap Band surgery? I've heard of sleep apnea, hyper tension. Know of a more broader list? I have Medicaid. PS... The hospital kept me overnight from a swollen Pancreas. Can this be a possible result from over-eating? Please help.

Hi All. I have been lurking and reading for sometime now but finally registered today. What a great group of people! :biggrin1: I was asked by my surgeon's office today to get a "note from my PCP stating she has seen me for at least the past year regarding morbid obesity." Has anyone else been asked to provide something like this? This note and proof that I've been overweight for at least 3 years is all that is keeping me from insurance approval. Has anyone else had to provide anything along these lines? Any suggestions? Thanks in advance!

Well I feel like things are starting to move. My paperwork was submitted to my insurance company today and they will call them next week to see what the status is! Crossing my fingers and my toes!!!

When I started this whole process I ran into someone that told me to make sure that my paperwork gets to the "Care Coordination Department" @ UHC. I just called and they received it on Friday and it's in review status with the correct department. He said it can take up to 30 days but that it's usually quicker and that I should call back on Friday so see if it's been approved yet. UGH! I'm soooooo excited with visions of tiny Old Navy clothes dancing in my head!! LOL! I sure hope I'm not setting myself up for disappointment

Horray! Just got a call from the surgeon's office and I've been approved. Surgery set for December 11th. It took just over 3 weeks since my first consultation with Dr. Abkin.

I want to do it ( banding that is) and I'm not sure if I should see doctor first or go straight to the ins co for approval. Can the doctor help me with the approval process? What should be my first move to having ins pay?

Since Blue Cross of CA PPO is coving my surgery on Dec 3rd... I'm guessing my first fill is in Jan. My insurance is changing to UHC PPO. So my question is... UHC PPO will cover fill cost or i gotta pay full cost??

I currently have Kaiser we are switching over to blue cross /blue shield, I was wondering how long should I wait to start this. I am excited and eager to get this done. But should I wait since we are just starting with them?:help:

I have medicare and I heard you need a psychological eval before getting approval. I have maniac depression and obsessive complusive disorder. Both are controlled well with medication. Though I was wondering, would this stop you from getting your approval? Do you need no mental disorders to pass the eval? Has anyone else passed with one of these with conditions? Fae

I got my approval today. Six weeks from submission to approval. No I'm not as calm as this sounds... I'm waiting on pins and needles for a call to schedule. Thanks to all who have provided support and listened. Ellisa

can anyone give me their experiences with UHC, BMI of 40 or below with no comorb. Thanks

I was denied coverage by Horizon. The denial was because I could not produce five years of written proof I have been overweight. I ignored their denial and went ahead and had the surgery as a self pay. So far they have paid 80% of my doctor's fee ($6k), 100% of my anesthesiologist's fee ($2.4k), 100% of my fill fees, and lastly they are giving me some grief on the hospital bill. It was $13k, and they have paid $2k so far. They are saying something about the hospital benig out of network, but I'm making sure today that means I have to pay that much (I know out-of-network means extra costs, but I have a PPO and the insurance usually covers at least 50%). Anyway, I wen…

I feel like I want to shout this from the roof tops...I finally got Approved after almost a year of fighting with Insurance Company..I went to 2 appeals denied both times waited 6 months and resubmitted and was approved in 3 weeks...I just want to tell everyone who has to fight with the insurance company... Dont give up..Keep trying... It does work out.....Yea:whoo:

I am getting UHC in Jan and will have my 1st consult with Dr. Turnquest in Houston jan 3. I am concerned that I won't get coverage because my BMI is 39 and I don't have co-morbidities. I will do the surgery regardless, but I am looking for financing options in the event that insurance denies. Can anyone help? I can only afford about $250-$300 a month on a loan payment. starting weight 223

i posted awhile back about UHC but now I found out that my company is switching INS in Jan. I did get to look at the plans offered and on all of them it shows a LTM of 10k for morbid obsesity. I havent signed up for the plan yet, but I will be getting the better on with no deductable and only a $100 copay for hospital stay. I am not sure what else it covers but I am hoping to get approved and everything by March or sooner! does anyone else have bcbs of sd? randi

Hello. I'm 5'5" or 5'6" and weigh 185 or so. My BMI is around 31. I can't get this weight off and it's been on for about 7 years or so. Does anyone know if I would be eligible for Lapband and insurance pay for it? I play tennis once a week and I feel like I'm falling apart...I've got plantar fascitis (spelling?), my ankles are killing me, my knee and my hip. I can see myself just getting worse if I can't get this weight under control and get it off. jodi

I have Benefit Options for AZ State Government Employees. Does anyone else have this? Any experience? TIA

Looking for someone with this insurance who has had the lapband done? Connie

Does anyone have any experience with Cigna and them coving reconstructive surgery after you reach goal?

Is anyone familiar with the BCBS PPO plan for SC state employees? I am getting ready to take this plan and know they took WLS off the benefits list a couple of years ago, but hoping they have added it back or might be for 2008. I also heard that since the surgery itself isn't covered, they don't cover any complications caused by the surgery/band. If anyone is familiar, let me know please!!!

I have Bcbs of alabama....they require you to attend a 6 month physician monitored program for 6 months (7 total visits)......Get this... Last visit on Dec 4th ... I have everything lined up to get approval/deny letter....but they want 3 years prior weights......guess what? I don't HAVE proof of 3 years prior weight. Just 2006 and 2003 - NOTHING from 2004 or 2005. Has anyone had this issue??? Please help if you have. i do not want this to be the reason for me not getting the surgery

Well my surgeons office just called me they are submitting my paper work tomorrow for approval. Boy am I getting nervous. Maybe I shouldn't read so much on here and other forums. Keeping my fingers crossed. :rolleyes

I phoned my insurance company on Friday 11-16-07 to check on the status of my pre-auth request and it was approved within three days . This process has been long and not without it's challenges. My first doctor only did the RNY. I was going to go through with it but finally realized it was not what I wanted and then began to pursue the lap band. My second doctor did the lap band, but after research I found out that the $5,500 after care fee above and beyond the insurance requirement was an additional expense was not needed. Phoned the insurance company about the fee to see if it was "standard" that is when I found out it was not. . They were wondering exacting what I…

Does anyone have BCBS Arizona? Of so have they been approved for the lapband? Thanks

Hello Everyone, I am almost finished with the pre op stuff and ready to get a date. I am self pay since my insurance has a WLS exclusion. Does anyone know if the insurance company will deny paying for the pre-op testing?? I am getting my surgery at Weight Loss Clinic in Harrisburg, PA. I could not see myself going to Mexico when I could get it done at home for 13K. If anyone has this experience please let me know. Thanks!

I'm currently with Blue Cross of CA and next week our open enrollment for insurance starts and they are no longer offering Blue Cross. So now I gotta choose UHC PPO or Kaiser of CA. I finished my Psych Eval (yesterday), sleep Test (have sleep apeana), and just couple more steps then ill be finished to send into insurance. I'm thinking that if I send in the stuff to Blue Cross that they will deny me cause my insurance is ending at end of Dec. So is it best to wait Jan and send it into UHC? or send Blue Cross ASAP? Only problem I have is with UHC is that I don’t have 5year record of BMI 35+ Medical. I have record from 2001 (BMI 37) then 2006 (BMI 42) and 2007 (BMI 46…

My insurance company is giving me grief. They are calling LapBand experimental for someone with my BMI ( mine is like 68.5..they say it is experimental over 50). I am compiling statistics for my appeal. They basically want me to prove them wrong, that it can work for someone my size. So if you had a starting BMI of 50 or more and you would like to help me all I ask for is the following: Your name: first name and last initial is fine. State: Age: Height: Weight on day of surgery: BMI day of surgery: Date of your surgery: Current weight: Current BMI: If you care to help I would really appreciate it. You can post the replies here or you can email them to m…

I was just wondering if anyone has used GHI and what their experience has been in getting approved through them. I work for NYC Dept of ed as a Speech Language Pathologist in the schools. I haven't even gone for any appointments yet, I am just starting this process. I have been reading the boards for about two months now. Please let me know if anyone has had experience with GHI. I am looking into getting this done at NYU. Thank you!!

yaya!!!!!!!!!!!!!!

My information was sent into Cigna and I call every day. Well, this morning the calling paid off. I found out the person that had received the information sent it to the wrong department and the person I was speaking with on the telephone took it upon herself to correct everything and get the information sent to the correct department (I hope). My suggestion: If you have Cigna, call, call, call and call some more. You never get the same person nor the same answers but every now and then you do get a person that seems to care about their job and will do what is necessary to help you, the paying insured. People insured by Cigna work much too hard to get to the i…

I went to the information seminar tonight at Silver Cross Hospital with Dr. Joyce tonight in Joliet and before I left I asked some questions about Medicare coverage so I thought I'd let you all know the answers. Ok of course if you can find a surgeon that is at a Center of Excellence and you have a BMI of 40 or over or a BMI of 35-39 with at least one comorbidity then Medicare will pay all but 20%. I specifically asked about fills b/c everything I have been reading has said that fills are not covered. That's not true as long as the Dr's office bills them correctly. They will cover fills begining 90 days post-op as long as they have the correct billing code. Th…

Ok so now I'm worried after reading all of the nightmare Aetna stories. I was under the naive impression that approval wouldn't be that difficult but it appears that it is. So as someone else mentioned it is open enrollment time and I'm wondering if anyone has any experience with Keystone Healthplan East. Don't get it, if it's a covered procedure why do they make it so difficult?? Dang!!!:faint: Anybody have KHE that can impart some wisdom on me//

I posted an apology to the BELITE company and the members on this site yesterday saying that I am sorry for writing what I wrote about them. Once more it isn't true. They aren't WIENIES and I am truly sorry to have said such a mean thing. They helped me when no one would. Through them I was able to have the sugery that I was unable to get on my own in three years. They are professionals and dispite what I said they were there for me and their other customers as well. I want to apologize once more, especially if you are a future customer.

Help! I have been preparing and going to the Dr and Nutritionist since April 2007. I fulfilled all of my requirements Sept 28th. My Dr was out of the office until Oct 3rd to sign the letter requesting pre-cert. Anthem PPO of Indiana took over 3 weeks to enter the request, then approval came Nov. 3rd. I called the office that Monday morning and they got me in to see the Nutritionist and the regular Dr on Nov 7th. At the end of the appt they scheduled me to see the surgeon on Dec 7th-telling me there was no way I could be scheduled for surgery before Jan 1st. I had let them know back in September that my insurance was changing, and the urgency of the matter. Of c…

Hi. It's time to re-enlist with insurance for my employer and I have a choice to make. Should I choose BCBCNC or Cigna? I currently have Cigna and I know that they cover lap-band surgery, but i'm worried that I may not be approved. My BMI is 47 and I have very mild sleep apnea and a herniated disk, but otherwise no other co-morbidities. Any advice would be much appreciated.

Please send good thoughts and prayers my way... I just verified with UHC that they have my packet and it's in the approval/denial process. They received it on the 10th and say it will take 15 days for a decision due to it being the end of the year. I am on a really tight time line trying to get this approved and the surgery performed before the 1st of the year when my INS will switch to Cigna. I will have little time for appeal if they decline me. All good thoughts, vibes and especially prayers are welcome. I want to have this done so very bad! Thank you!!!

I have really good insurance. I was approved for the lapband procedure and my insurance will cover 100%. I received a letter in the mail from my insurance detailing everything. I received a call from the doctor office late last week telling me that I was NOT approved and that I would need to finance my procedure. I quickly told them that I was in fact covered 100% and that I already new that the Doctor was also 'in network'. Thinking the office assistant was missinformed I asked her to read the letter my insurance sent her and to call me back. The doctors office called me back on Friday afternoon. This time they tell me that the doctors in office surgery clinic …

To those of us that have BCBS MI- There have been many ?'s about 12 mos. visits with doctor doing supervised diet- Well here is what I found out. You do not have to go to the doctor every month for 12 mos. what you do have to do is show that periodically in 12 consec. mos. that you have been over weight and failed at the attempts to lose weight. Which makes a lot more since.:clap2:

Does anyone know if you have to show five straight years of being obese or can you skip years here and there. See I might not have it documented five straight years but I have been obese for about 10yrs. I wasn't seeing my Dr. all the time becuase he would write prescriptions over the phone? Also can I get my weight history from my foot Dr. becuase I saw him for other things that had to do with my weight and my foot?

Hello all, My insurance is Cigna and I am covered for the actural surgery (code 43770) but my insurance excludes treatment for obesity. So when I go to the doctor for my required monthly visits, sometimes they are denied. I call Cigna and get a different answer every time I call, depending on who I talk to. Anyone out there have this same situation with their insurance? I am totally confused. :help:

I was just accepted by them and was wondering how credible they are and does anyone have any experience with them ? And if you do, based on the fact that they accepted my case, what do you think my chances are ? Are they usually successful ?

Lots of folks have been waiting for this news, so hopefully this will help some of you "self-paid victims of erosion" finally relax. After 2 years of appeals, Blue Cross finally reversed their decision, and they just covered the $37,500.00 two-day hospital stay for reversal surgery. For the record, band placement was not covered, so insurance refused to cover the emergency removal (due to erosion) since the initial procedure isn't covered. After 2 years of fighting their decision, Blue Cross responded: "After careful review of the additional information provided, it was determined the previous denial will be overturned as the services are, medically necessary base…

Hi all! If you have United Healthcare I was wondering if you could tell me a few things. My first question is, did you have to go through a supervised diet before they would approve you? And my second question is, how long did it take you to get your approval? I'm very anxious about my consultation coming up on Dec. 3rd, i'm just so ready to get this ball rolling so I can KNOW, I'm not good at being patient...lol. I've talked to the customer service people at UHC several times and have never got a straight answer to the supervised diet question, one person said it wasn't likely, one person said he's never seen a person have do one, and one person said it's case by…

Will I have to switch to BC/BS PPO to get approved? <p>Will I have to switch to BC/BS PPO just to get the lap band, or has anyone had the procedure with a HMO?</p>

:kiss2::clap2::whoo:My request for lapband authorization was submitted on Nov. 1. It was approved on Nov. 4. I am still in shock. I don't have it in writing yet but I have the approval number. I'll post my surgery date as soon as I know it. This gives me a whole new meaning to "down side"!

This is my issue..... I switched doctors a year and a half ago.. the old clinic I used to go to, I would always 'opt out' of being weighed because I was so embarrassed about the skinny little nurse seeing my weight. So Im not sure if I can provide proof of being so heavy for so long :c(. I stopped letting them weigh me. Am I screwed? The woman in insurance coordination says that if Aetna denies me, they have a lawyer that for 1100$ will take the case and run with it. Has anyone with Aetna been denied and then had their appeal overturned? I want this so bad and will be devastated if I cant get banded because I had such low self esteem those years ago. :help: